Too many doctors and nurses, said the health secretary Patricia Hewitt last week when asked to explain NHS deficits. Lisa Hitchen demurs (doi: 10.1136/bmj.39044.677280.DB). People interviewed for the BMJ said that rising debts were because of primary care trusts struggling with their new role as commissioners and over hasty reorganisation. Is this special pleading? Chris Ham thinks not. Government policies have accentuated the challenges of long term change in service provision, he writes (doi: 10.1136/bmj.39044.592662.BE). Improvements will not come simply through the invisible hand of the market.

Does this mean that practice based commissioning is not the panacea policy makers had hoped for? Ian Greener and Russell Mannion find that it shares many of the problems of fundholding (as well as some of its potential benefits) and will have little effect on hospital care (doi: 10.1136/bmj.39022.486921.94). They think the way forward is to go back to the primary care groups model of 1997, which was introduced to tackle the problems of fundholding. More doctors in management and politics would also help, says Adam Greenbaum (doi: 10.1136/bmj.39045.400220.1F).

Management and political skills are not yet, but perhaps should be, on the list of competencies that junior doctors need to acquire as they navigate the labyrinth of the United Kingdom's new training structures. This week's Career Focus (www.careerfocus.bmj.com) should help to demystify the reforms embodied in Modernising Medical Careers (MMC). My reading is that the rationale of MMC is excellent—it has the potential to deliver far more coherent training and development for doctors; but the implementation has fallen on the shambolic side of ideal.

Junior doctors, and those advising them, are still largely in the dark about the process, but there is little likelihood that calls for the new system to be postponed will be heeded. MMC's national director, Alan Crockard, believes it is time to “take a very deep breath and get on with it” (doi: 10.1136/bmj.39028.480417.7D). Those applying in January may find comfort in the view that “while the MMC application process seems shrouded in mystery, it will be almost identical in its requirements to the current system we know and love”.

UK medical students should find that it has all been resolved by the time they qualify, which means they can get on and enjoy reading the studentBMJ. We know that it is also read by many doctors, especially clinical tutors who use the material in their teaching. You can access it free online (www.studentbmj.com). The December issue marks 25 years since the first case of HIV/AIDS. In it Robert Gallo, co-discoverer of the virus, reminds us that the disease kills more than 250 000 people—akin to a tsunami—every month. He calls for sustained research to find new ways of preventing and treating this global pandemic. In a personal view in the BMJ (doi: 10.1136/bmj.39048.719525.59), the editor of studentBMJ, Balaji Ravichandran, writes, if we are to achieve the dream of not “celebrating” the 50th anniversary, we need to act fast.